A Case of Traumatic Abdominal Wall Hernia Overlooked at the Time of Laparoscopic Surgery

Abstract

A 29-year-old man had sustained injuries in a traffic accident and was admitted as an emergency. Subcutaneous hemorrhage with a seat belt sign was found on his lower abdomen. A whole-body CT scan revealed multiple bone fractures and fluid collection in the peritoneal cavity. Pneumoperitoneum was not detected and diagnostic laparoscopy was performed. At laparoscopy, a small amount of unclotted blood was found with laceration of the sigmoid colon and mesenteric injuries. He underwent sigmoid colectomy. On 2 days after surgery, however, he had abdominal distention with nausea. A CT scan showed the laceration of the rectus abdominis muscle and herniation of the small intestine into the defect. He was diagnosed as having a traumatic abdominal wall hernia and underwent a reoperation. At laparotomy, disruption of the fascia and the peritoneum were found not at the port site but at the linea alba near the arcuate line. The patient underwent a partial resection of the small intestine and a direct suture of the rectus abdoministo repair the abdominal wall hernia. The number of diagnostic laparoscopies for patients with abdominal blunt trauma has been increasing. A traumatic abdominal hernia should be kept in mind as a probable differential diagnosis, since it is easily overlooked in laparoscopic surgery.